Complex needs and complex solutions: the challenge of profound intellectual and multiple disabilities

People with profound intellectual and multiple disabilities (PIMD) have been the subject of diametrically opposed philosophies. Bioethicists have denied their personhood because of their lack of self-awareness and low level of cognitive functioning. Such a view has been used to justify both euthanasia and surgical and hormonal intervention to stunt growth, as in the case of the much publicized “Ashley’s treatment.” In contrast, their rights as persons and citizens have been asserted, and rich veins of research over the past 60 years have explored their capacity for development and the contexts in which they live. Against this background, the author speaks to the key issues affecting people with PIMD and introduces the papers that are included in this special issue that deals with the need for the development of a careful classificatory approach to PIMD; practice in service settings for both children and adults; approaches to intervention; health-related concerns; and the quality of life of staff